Crit Care:右美托咪定对需要机械通气的脓毒症患者炎症的影响

2021-03-02 MedSci原创 MedSci原创

右美托咪定是一种高选择性的α2-肾上腺素能激动剂,广泛用于机械通气时患者的镇静。既往研究显示,右美托咪定可降低炎症动物的IL-6和TNF-α水平,改善其炎症反应。此外,给予右美

右美托咪定是一种高选择性的α2-肾上腺素能激动剂,广泛用于机械通气时患者的镇静。既往研究显示,右美托咪定可降低炎症动物的IL-6和TNF-α水平,改善其炎症反应。此外,给予右美托咪定还可降低接受手术的人体内IL-6、TNF-α和CRP的水平。但是右美托咪定是否也能降低脓毒症患者的炎症反应,目前尚不清楚。

为了研究给予右美托咪定对脓毒症诱导的炎症的影响,来自日本的研究人员进行了一项多中心随机临床试验,比较了脓毒症患者接受或不接受右美托咪定治疗14天的结果,研究已发表于Crit Care。

研究纳入201名使用机械呼吸机支持的脓毒症成人患者,使用(DEX组,100例)或不使用(非DEX组,101例)右美托咪定进行镇静。比较了两组治疗前14天的CRP和降钙素水平,评估了14天的死亡率、白蛋白水平和弥散性血管内凝血(DIC)的患者数量。使用广义线性模型来估计组间这些结果的差异,使用Kaplan-Meier方法估计14天死亡率,并使用对数秩检验评估组间差异。

 

结果显示,在14天治疗期间,DEX组与非DEX组的CRP和降钙素水平较低[CRP-范围,5.6-20.3 vs. 8.3-21.1 mg/dL(P = 0.03);降钙素-范围,1.2-37.4 vs. 1.7-52.9 ng/mL(P = 0.04)]。DEX组白蛋白水平(范围,2.3-2.6 g/dL)高于非DEX组(范围,2.1-2.7 g/dL;P = 0.01)。各组之间DIC患者的比例没有显著差异(范围,DEX组和非DEX组分别为21-59%和17-56%;P = 0.49)。DEX组和非DEX组的14天死亡率分别为13%和21%(P=0.16)。

综上所述,该研究结果表明,使用右美托咪定的镇静剂可以降低需要机械通气的脓毒症患者的炎症水平。

 

原始出处:

 

Yoshinori Ohta, Kyohei Miyamoto, et al., Effect of dexmedetomidine on inflammation in patients with sepsis requiring mechanical ventilation: a sub-analysis of a multicenter randomized clinical trial. Crit Care. 2020 Aug 10;24(1):493. doi: 10.1186/s13054-020-03207-8.

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    2021-04-10 jywsoar

    好药

    0

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    2021-03-03 1209e435m98(暂无昵称)

    学习了,谢谢分享

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    2021-03-02 jyzxjiangqin

    好文章!

    0

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    2021-03-02 科研科研科研

    厉害~

    0

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    2021-03-02 Marianne94

    学习

    2

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2020脓毒症预防和阻断专家共识告诉你:这些血清标志物很重要!

目前国际指南对于脓毒症的最新定义为,由感染引起的宿主反应失调,进而导致循环功能障碍及器官功能损害。

Am J Respir Crit Care Med:平衡晶体液可较生理盐水降低脓毒症患者的住院死亡率

静脉注射晶体液是治疗脓毒症的基本疗法,但晶体液成分对患者结局的影响仍不清楚。本研究旨在比较平衡晶体液与生理盐水对重症成人脓毒症患者30天住院死亡率的影响,研究结果已在线发表于Am J Respir C

Lancet:ECMO用于脓毒症心源性休克患者的治疗

ECMO有助于可提高脓毒症心源性休克患者的存活率

Crit Care:阿黑皮素原(POMC)在ACTH-皮质醇解离中的作用

脓毒症的典型特征是血浆(游离)皮质醇升高和皮质醇降解受到抑制,而血浆促肾上腺皮质激素(ACTH)水平没有增加,被称为“ACTH-皮质醇解离”。

Chest:早期脓毒症和脓毒性休克患者右心室功能障碍的临床意义

将近一半的脓毒症患者中存在右心室功能不全,并且其与患者28天死亡率高出三倍以上有关。